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确定微创反流性手术的学习曲线:系统性审查,元分析和元回归
Jonathan Sivakumar1,2,3, Qianyu Chen4, Nicholas Bull1,2
1Department of Upper Gastrointestinal Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
概括
这项研究发现,外科医生需要大约25例腹腔镜手术和31例机器人反流体手术才能达到熟练程度. 学习外科医生面临更高的转换风险,并发症和重新干预的风险,突出了需要代理人的需要.
科学领域:
- 最少侵入性的手术
- 外科教育的外科教育
- 胃肠道手术 胃肠道手术
背景情况:
- 越来越多地采用微创抗逆流体手术.
- 了解外科医生的学习曲线对于患者安全和外科培训至关重要.
研究的目的:
- 确定腹腔镜和机器人辅助抗逆流手术的学习曲线.
- 为了比较外科医生在学习和经验阶段之间的手术结果.
主要方法:
- 对学习曲线在最少入侵的基金复制的文献进行系统的审查.
- 进行元回归分析以估计熟练程度所需的病例.
- 进行元分析,比较学习阶段与经验阶段的结果.
主要成果:
- 预测的学习曲线为腹腔镜手术的24.7例和机器人反流体手术的31.1例.
- 在学习阶段的外科医生转换为开放外科手术 (OR 2.44),手术内 (OR 1.60),术后 (OR 1.98) 和重新干预 (OR 1.64) 的并发症率更高.
- 25项研究符合资格标准.
结论:
- 在抗逆流体手术方面的能力需要大量的病例.
- 在学习阶段增加的风险强调了指导和监督对新手术医生的重要性.
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